How to assess the risk of postoperative orthostatic hypotension in patients with degenerative cervical spondylosis: a prospective cohort study

Background: Patients with degenerative cervical spondylosis (DCS) undergoing surgical treatment often face hidden postoperative complications, particularly orthostatic hypotension (OH), which significantly impacts early postoperative ambulation and rehabilitation. It is particularly important and urgent to identify high-risk patients who are prone to OH after surgery in advance and then implement targeted preventive measures. We plan to take the lead in developing a nomogram that can predict the risk of postoperative OH prior to first out-of-bed mobilization to guide clinical practice. Materials and methods: A cohort of 694 surgical patients diagnosed with DCS in a single hospital (Xijing Hospital) was randomly assigned to a training cohort ( N = 463) and a validation cohort ( N = 231) with a 2:1 ratio. Additionally, 160 DCS surgery patients from the 970 th Hospital constituted the test cohort. The LASSO regression was applied for variable selection. A nomogram was constructed according to the coefficients of variables in the logistic regression, and its performance in terms of discrimination, calibration, and clinical utility was assessed across all three cohorts. Results: This study included 854 patients (median range age, 55 22–83 years; 539 63.1% male). OH occurred during the first out-of-bed mobilization in 25.9%, 25.5%, and 28.1% of DCS patients across the three cohorts, respectively. Six key predictors were identified: preoperative OH, history of hypertension, pulse pressure, spinal cord hyperintensity, bed rest duration, and history of dizziness. The discriminatory power of the nomogram was 0.914, 0.900, and 0.896 in the three cohorts, respectively, accompanied by excellent calibration and clinical utility. Based on the optimal cutoff value, DCS patients with a Nomogram total score ≥142.19 are identified as high-risk populations for OH. Conclusion: This study developed and multi-validated the first nomogram for predicting the risk of postoperative OH in DCS patients, which will help clinicians identify high-risk populations early and provide appropriate preventive measures for them.